Bunion Surgery: Everything You Need to Know

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Bunion surgery fixes a bony outgrowth at the base of the big toe that forces it inward. The growth is called a "bunion" or hallux valgus. Surgery for a bunion can involve cutting and realigning bone, repositioning muscles, tendons, and ligaments in the foot; and fusing or replacing a joint.

Bunions only need to be treated if they're causing discomfort. Surgery for a bunion is not usually the first option. For example, wearing a bunion cushion or special foot insert in your shoe is sometimes enough to deal with a bunion.

If you've tried other bunion treatments but symptoms are getting in the way of your activities (like affecting your ability to walk), you might consider having bunion surgery.

This article will go over the different kinds of bunion surgery, what to expect from the procedure, and how to handle recovery from having a bunion removed.

Woman's feet with bunions
bgwalker / Getty Images

What Is Bunion Surgery?

Bunion surgery is done to restore the affected toe to its normal position with the goal of reducing pain and improving function.

Bunions form along the big toe. Outgrowths on the other side of the foot just below the pinky toe are called bunionettes. These growths can also be fixed with bunion surgery.

Usually, you can have bunion surgery as a same-day outpatient procedure and won't need to be admitted to the hospital.

You might think that bunion surgery is just shaving off the bunion, but that usually does not work because the bunion can come back. Instead, bunion surgery involves removing the bony outgrowth and cutting and straightening the affected toe bone.

The surgeon will also reposition the tendons and ligaments in the foot. This can include tightening the ligaments on the outside of the toe and loosening the ligaments on the inside to create the tension needed to get the toe back in the right position.

If the toe was cut, it can be stabilized and held in place with metal plates, screws, or wires while it heals.

Open vs. Minimally-Invasive Bunion Surgery

Bunion surgery can be done in a couple of ways. One is a traditional open approach, which requires a bigger incision to be made in your skin of your foot.

The other option is minimally invasive surgery, which uses small keyhole incisions, special surgical instruments, and an imaging technique called fluoroscopy.

This method doesn't require any big cuts to be made and also tends to have a faster recovery time and lower risk of infections and other complications compared to open surgery.

However, people with more severe bunions might need to have open surgery because the less invasive option would not be enough to fix the problem.

Even though bunion surgery is usually quick, it requires a skilled surgeon who understands the anatomy of the foot and has experience with bunions.

Types of Bunion Surgery

There are over 150 types of surgeries for bunions. These are the most common types of bunion surgery used today:

  • Bunionectomy: Removing the bony outgrowth and realigning the muscles, tendons, and ligaments around the affected joint
  • Osteotomy: Cutting the toe bone to put the affected joint in a straighter position with pins or screws
  • Arthrodesis: Fusing the bones around a damaged joint (that's been removed) using screws, wires, or plates
  • Arthroplasty: Removing the damaged part of a joint and allowing scar tissue to fill the space between the two bones (the joint can be replaced with an implant)

In all types of bunion surgery, the soft tissues around the joint, including tendons and ligaments, are also rebalanced to keep the deformity from coming back. This is called soft tissue repair.

The type of bunion surgery that's right for you will depend on the severity of the bunion (mild, moderate, or severe), whether you have arthritis in the toe joint, and the surgeon's experience.

Procedure   Mild Bunion  Moderate or Severe Bunion  Severe or Arthritic Bunion
 Bunionectomy  √  
 Osteotomy    √  
 Arthrodesis      √
 Arthroplasty      √
Soft tissue repair

Your surgeon will take factors like your age, activity level, overall health, and the severity of the bunion into account when deciding on which bunion surgery (or combination of surgeries) would benefit you the most.

Who Cannot Have Bunion Surgery?

Some people cannot have bunion surgery because they have health conditions or circumstances that would make it unsafe (contraindications). You may not be able to have bunion surgery if you have:

Can I Have Cosmetic Surgery to Fix a Bunion?

Bunion surgery is not done if a person does not have symptoms related to the bunion and only wants to have surgery to change how their foot looks (cosmetic surgery).

What Are the Risks of Bunion Surgery?

Any surgery has risks. There are also some specific risks of having bunion surgery that you should know about.

Potential risks of bunion surgery include:

  • Stiffness or scarring of the big toe
  • Wound infection
  • Nerve injury that causes numbness or continued pain
  • Failure of the bone to fully heal (nonunion)
  • Recurrence of the bunion
  • Avascular necrosis of the big toe bone

Why Bunion Surgery Is Done

The purpose of bunion surgery is to alleviate pain and restore function by removing the bony outgrowth and realigning the joint.

Bunion surgery is generally considered if you have one or more of the following issues related to the bunion:

  • Significant pain that affects your ability to engage in your normal activities of living (e.g., walking a few blocks, wearing sneakers)
  • Bunion-associated toe pain, redness, swelling, and/or stiffness that does not get better with rest or taking a nonsteroidal anti-inflammatory drug (NSAID)
  • Toe deformity (e.g., the big toe begins to overlap or underlap the toe next to it)

If you are considered a good candidate and want to move forward with bunion surgery, your surgeon will order special foot X-rays to help them plan your procedure.

You will also need to see your primary care provider for tests to make sure that it would be safe for you to have surgery. For example:

How to Prepare for Bunion Surgery

If you're considering bunion surgery, you'll want to find out how much it will cost to remove a bunion. The first step is to contact your insurance provider and ask how much they will cover. Then, you can get an idea of what the out-of-pocket costs for bunion surgery might be.

Once you are scheduled for bunion surgery, your surgeon will give you instructions on how to prepare for the procedure.

You need to follow the instructions carefully because they are meant to help avoid problems before, during, and after the surgery. If you have questions, make sure you get in touch with your surgeon to ask them before the day of your appointment.

Where Is Bunion Surgery Done?

Bunion surgery can be done in a hospital, a surgical center, or an office by an orthopedic surgeon or podiatrist.

Your surgeon will want you to arrive at the location about one to two hours early on the day of your operation.

Food and Drink

You will not be able to have anything to eat or drink eight to 12 hours before surgery (fasting). The exact timing will depend on the type of anesthesia you will be having during the procedure.

Medications

You may need to stop taking certain medications, like NSAIDs, a few days before having bunion surgery.

Tell your surgeon about all the medications you take, including prescription and over-the-counter (OTC) medications, herbal products, supplements, vitamins, and recreational drugs.

What to Wear and Bring

You will change into a hospital gown when you arrive for your surgery, so wearing something loose-fitting and easy to take off will make the process go faster and also help you feel more comfortable after surgery. Do not wear any jewelry, including any body piercings.

A special boot will be placed on your foot after surgery, so it can help to wear sweatpants that can easily fit around it. You could also bring shorts to change into before you go home.

You'll need a supportive, non-slip shoe with a rubber sole to wear on the foot that was not operated on.

On the day of your surgery, make sure you bring these things with you:

  • Driver's license and insurance card
  • List of your medications
  • An assistive device, such as crutches or a knee walker, to be used after surgery (talk with your surgeon beforehand about what device they recommend)

You will need a family member or friend to come with you on the day of your procedure because you will not be able to walk or drive after. You will need someone to take you home after your surgery is done.

Pre-Op Lifestyle Changes

If you have health conditions like diabetes or high blood pressure, it's important that you take steps to manage them leading up to your surgery.

If you smoke, you will be asked to stop for at least a few weeks before your operation. Smoking increases your risk of wound and bone healing problems after surgery.

What to Expect on the Day of Surgery

On the day of your bunion surgery, you get to the hospital or office a few hours before your surgery is scheduled. You will check in, your insurance will be verified (if you have it), and you will sign consent forms.

Before the Surgery

You will be taken to a pre-operative room to change out of your clothes and into a hospital gown. A nurse will go over your medication list, take your heart rate, blood pressure, temperature, and other vitals. and put an intravenous (IV) line into a vein in your arm so you can get fluids and medications.

Your surgeon and anesthesiologist will come to say hello and talk to you about the operation and answer any questions you have. Then, you will be wheeled into the operating room on a gurney.

During the Surgery

Bunion surgery can be done under local, general, or spinal anesthesia.

  • Local anesthesia: The surgeon puts medication in your ankle to numb your entire foot. You may feel a stinging sensation as the medication is being injected. You will also be given a sedative to help you relax and fall into a light sleep during the procedure.
  • Regional anesthesia: An anesthesiologist puts numbing medication into your lower back (spinal block) or behind your knee (popliteal block). You will be awake but you will not feel pain or other sensations in the numbed part of your body. You will also be given a sedative to help you relax.
  • General anesthesiaAn anesthesiologist will "put you to sleep" by giving you inhaled or IV medication. You will not feel anything that occurs during the surgery and you won't remember anything about it. After you are asleep, the anesthesiologist will put a breathing tube called an endotracheal tube into your mouth and windpipe. The tube is connected to a ventilator to help you breathe.

Once the anesthesia has taken effect, a surgical assistant will clean the skin on the foot that's being operated on with an antiseptic solution to kill any bacteria.

What happens during the surgery will depend on your case, but these steps are part of most surgeries for a bunion:

  • Incision: The surgeon will make one or more incisions along the inside of or on top of the affected joint. The size of the incision depends on whether the surgery is open (larger) or minimally invasive (smaller).
  • Bone removal and/or cutting: The surgeon will do one or more specific procedures based on the severity of the bunion (e.g., removing the bunion or cutting the bones to realign the joint).
  • Bone stabilization: If the toe bone was cut, it will be held in place with screws, plates, or wires.
  • Soft tissue repair: The soft tissues (tendons and ligaments) around the affected toe will be shortened or lengthened to bring the affected toe back to its proper position.
  • Closure: The incision(s) will be closed with stitches and your foot will be wrapped in a soft gauze bandage. A special supportive boot with self-fastening closures will then be placed over your foot.
  • Prep for recovery: If you were given general anesthesia, it will be stopped and the breathing tube will be taken out. You will be taken to a recovery room where you will wake up.

How Long Does Bunion Surgery Take?

The operation time for bunion surgery is usually less than one hour, but it can take longer based on what procedures are being performed.

In most cases, only one foot is operated on during the procedure. If you need to have a bunion on your other foot removed, a second surgery can be scheduled.

After the Surgery

In the recovery room, a nurse will monitor your vital signs. Once you are awake—around one to two hours after surgery, or longer if you had general anesthesia—you will be allowed to go home.

Recovery From Bunion Surgery

As you recover from bunion surgery at home, you will have instructions to follow including:

  • Keep your foot elevated on one or two pillows to help bring down any swelling. Your surgeon may also recommend icing your foot.
  • Take your medication as prescribed (e.g., opioid medication for pain or antibiotics to help prevent infection).
  • Keep your incision site dry. Your surgeon may tell you to remove your boot and cover your surgical dressing with a plastic bag and tape when you take a shower.
  • Avoid placing weight on the operated foot. When you have to walk, use an assistive device. Your surgeon will tell you when you can start weight bearing on your foot.
  • Do not drive until you are off all pain medications (usually a week or longer).

Since you won't be able to move around much in the first couple of weeks after bunion surgery, be sure to arrange for someone to help you with shopping and chores.

Finding a comfortable way to sleep after bunion surgery may take some trial and error. You don't want to put pressure on your healing foot, which could interfere with healing and cause pain. You might find that elevating your foot in bed helps with swelling and keeps you from moving it too much during the night.

Your surgeon may recommend daily foot and toe stretching exercises during your recovery to help you regain strength and range of motion in the foot after surgery.

Follow-Up

You'll go back to see your surgeon about one to two weeks after you have bunion surgery. At this appointment, your dressings will be changed and your stitches will be removed.

Even if your surgeon allows you to remove your boot at a follow-up appointment, you will likely still have to wear a foot brace or splint for four to 10 more weeks.

When to Call Your Surgeon

If you have these symptoms during your recovery from bunion surgery it could be a sign of a complication. Call your surgeon if you have:

  • Fever or chills
  • Redness, swelling, bleeding, or pus-like drainage from the incision
  • Increased pain around the foot or incision
  • Swelling in the calf of the leg on the side where you had surgery
  • Trouble breathing

Long-Term Care

You can expect to begin placing weight on your operated-on foot around two to six weeks after surgery, but you will still need to use an assistive device for up to 12 weeks after your operation.

When the swelling fully resolves, you can start wearing and walking with an athletic or soft-leather shoe.

The width of your forefoot will not change much after bunion surgery. In fact, the average correction of forefoot width is just a fraction of an inch.

Still, while some patients are able to wear slimmer shoes eventually (at least six months after surgery), others are not.

Possible Future Bunion Surgeries

Future surgeries for a bunion might be needed if you have complications.

For example, you might need a second bunion surgery if the bones do not heal after an osteotomy and realignment. If a new problem develops because of the surgery—for example, if the deformity is overcorrected and the big toe points inward—you might need to have revision surgery.

The causes of bunions are not always things you can control—for example, the way your feet are shaped or developing joint conditions. You might be worried that a bunion will "grow back" after surgery or that you'll develop more bunions.

Surgical correction of bunion recurrence can be challenging and require a lot of skill. Bunions can come back months or years after surgery, especially if the first attempt to fix it does not work well—for example, just shaving off the bunion without correcting the soft tissues of the foot.

Lifestyle Adjustments

Your surgeon will tell you that it's important to avoid smoking while you recover from bunion surgery because smoking can affect wound healing.

To prevent your bunion from recurring or from forming in the other foot, you need to wear shoes that are comfortable and have a wide toe box. Your toes should have enough wiggle room and good arch support. If you have to wear shoes with a narrower toe box, only do so for a short time.

Some studies have shown that maintaining a healthy body weight for your height also helps prevent bunion recurrence.

Summary

Bunion surgery can be helpful if a bunion that's causing you pain or affecting your ability to walk. The type of bunion surgery you need will depend on how serious the bunion is.

It can take some time to heal from bunion surgery, and you'll need to take steps to help prevent the bunion from coming back. Sometimes, you might need to have a second bunion surgery if the first one didn't fix the problem or if you get another bunion.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopaedic Surgeons. Bunion surgery.

  2. Singh MS, Khurana A, Kapoor D, Katekar S, Kumar A, Vishwakarma G. Minimally invasive vs open distal metatarsal osteotomy for hallux valgus - A systematic review and meta-analysis. J Clin Orthop Trauma. May-Jun 2020;11(3):348-356. doi:10.1016/j.jcot.2020.04.016

  3. Harvard Health Publishing. Harvard Medical School. What to do about bunions.

  4. Edwards WHB. Avascular necrosis of the first metatarsal head. Foot Ankle Clin. 2005 Mar;10(1):117-27. doi:10.1016/j.fcl.2004.11.001

  5. Ahmad, J. American Orthopaedic Foot and Ankle Society. How to Prepare For Foot or Ankle Surgery: Day of Surgery.

  6. Beahrs TR, Reagan J, Bettin CC, Grear BJ, Murphy GA, Richardson DR. Smoking Effects in Foot and Ankle Surgery: An Evidence-Based Review. Foot Ankle Int. 2019 Oct;40(10):1226-1232. doi:10.1177/1071100719867942

  7. Johns Hopkins Medicine. Bunion Surgery.

  8. Cleveland Clinic. Bunion Correction Surgery.

  9. Raikin SM, Miller AG, Daniel J. Recurrence of hallux valgus: a review. Foot Ankle Clin. 2014 Jun;19(2):259-74. doi:10.1016/j.fcl.2014.02.008

  10. Chen JY, Hui Lee MJ, Rikhraj et al. Effect of Obesity in Outcome of Hallux Valgus Surgery. Comparative Study Foot Ankle Int. 2015 Sep;36(9):1078-83. doi:10.1177/1071100715581449

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.